Courtenay Molly, Rowbotham Samantha, Lim Rosemary, Deslandes Rhian, Hodson Karen, MacLure Katie, Peters Sarah, Stewart Derek
School of Healthcare Sciences, Cardiff University, Cardiff, UK.
Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia.
BMJ Open. 2017 Mar 15;7(3):e013515. doi: 10.1136/bmjopen-2016-013515.
To (1) explore patients' expectations and experiences of nurse and pharmacist non-medical prescriber-led management of respiratory tract infections (RTIs), (2) examine whether patient expectations for antibiotics affect the likelihood of receiving them and (3) understand factors influencing patient satisfaction with RTI consultations.
Mixed methods.
Primary care.
Questionnaires from 120 patients and follow-up interviews with 22 patients and 16 nurse and pharmacist non-medical prescribers (NMPs).
Patients had multiple expectations of their consultation with 43% expecting to be prescribed an antibiotic. There was alignment between self-reported patient expectations and those perceived by NMPs. Patient expectations for non-antibiotic strategies, such as education to promote self-management, were associated with receipt of those strategies, whereas patient expectations for an antibiotic were not associated with receipt of these medications. 'Patient-centred' management strategies (including reassurance and providing information) were received by 86.7% of patients. Regardless of patients' expectations or the management strategy employed, high levels of satisfaction were reported for all aspects of the consultation. Taking concerns seriously, conducting a physical examination, communicating the treatment plan, explaining treatment decisions and lack of time restrictions were each reported to contribute to patient satisfaction.
NMPs demonstrate an understanding of patient expectations of RTI consultations and use a range of non-antibiotic management strategies, particularly those resembling a patient-centred approach. Overall, patients' expectations were met and prescribers were not unduly influenced by patient expectations for an antibiotic. Patients were satisfied with the consultation, indicating that strategies used by NMPs were acceptable. However, the lower levels of satisfaction among patients who expected but did not receive an antibiotic indicates that although NMPs appear to have strategies for managing RTI consultations, there is still scope for improvement and these prescribers are therefore an important group to involve in antimicrobial stewardship.
（1）探讨患者对护士和药剂师非医学处方者主导的呼吸道感染（RTIs）管理的期望和体验；（2）检查患者对抗生素的期望是否会影响其接受抗生素治疗的可能性；（3）了解影响患者对RTIs咨询满意度的因素。
混合方法。
初级保健。
120名患者的问卷调查以及对22名患者和16名护士及药剂师非医学处方者（NMPs）的随访访谈。
患者对咨询有多种期望，43%的患者期望开具抗生素。患者自我报告的期望与NMPs感知到的期望一致。患者对非抗生素策略（如促进自我管理的教育）的期望与接受这些策略相关，而患者对抗生素的期望与接受这些药物无关。86.7%的患者接受了“以患者为中心”的管理策略（包括安慰和提供信息）。无论患者的期望或采用的管理策略如何，患者对咨询的各个方面都报告了较高的满意度。认真对待担忧、进行体格检查、传达治疗计划、解释治疗决策以及没有时间限制均被报告有助于提高患者满意度。
NMPs表现出对患者对RTIs咨询期望的理解，并使用一系列非抗生素管理策略，特别是那些类似于以患者为中心的方法。总体而言，患者的期望得到了满足，处方者并未受到患者对抗生素期望的过度影响。患者对咨询感到满意，表明NMPs使用的策略是可接受的。然而，期望但未接受抗生素的患者满意度较低，这表明尽管NMPs似乎有管理RTIs咨询的策略，但仍有改进空间，因此这些处方者是抗菌药物管理中重要的参与群体。
